Medical Managed Care Plans
Medicare and Medicaid have an essential role in healthcare industries as they provide health services to people who are aged and also people who have low income. The healthcare delivery services, together with the managed care plan, are composed of Medicaid and Medicare, which are crucial since they play an essential role in balancing the healthcare services to the citizens. This report consists of the Medicare and Medicaid roles, the differences, and the similarities attached to the healthcare industry. This report also includes incentives that take place in healthcare services, weaknesses, and strengths. Lastly, the paper will consist of the recommended strategies that are done to improve services in managed care plans.
Question 1
Medicare and Medicaid were created in 1965, and this was after President Lyndon Johnson signed the social security amendment law. The government offers the programs, and they target people who are aged and the low income. Both of these two government-funded programs are organized to cover financial portions of the doctors who pay visits to the patients who are limited and can only receive medical services from their homes.
Medicare programs target the people above 65 years and have disabilities in various measures regardless of their earnings. On the other hand, Medicaid programs are also a governmental program that targets low-income Americans. The plan was enacted in 1965 and provided health and long term coverage (Holahan & Suzuki, 2012).
Medicare plan is divided into four distinctive parts. The parts include A B C and D. Each part of the Medicare has been allocated its functions. Part A covers services that doctors provide to patients at home (home health care). At the same time, Part B Medicare offers services such as visits by the doctor, ambulatory services, rehabilitation, and mental services. The part covers all the services that parts A and B provide. Part D covers the cost incurred in the process of prescribing the drugs.
Question 2
One of the Medicare program’s strengths is that the programs offer protection plans to people above 65, regardless of the payment. The program is also responsible for all the costs in the emergency clinics, doctor visits, required tests, and prescriptions.
Some of the strengths of Medicaid include giving protection covers to families. The Medicaid program charges are subsided, such as the clinic and emergency charges (Schirmer, 2018).
The apparent weaknesses in the Medicare plan are that they notably rely on persons’ status; this implies that patients are supposed to pay extra charges even if they have life-working partners. In the case of the off chance, they should be paying a little amount of premium if the Medicare plan does not cover other issues such as dental cover and the vision. The Medicare program should be spending at least some amount than letting the individual pay for the charges.
The government’s guidelines perpetuate that Medicare managed care should develop a plan of improving the health industry and administrations offered by the regulated care institutions. These guidelines ensure that the MCI is in line with the provision of sufficient supplies. There are some items issues under these plans which are considered and ought to be foreseen Medicare plans, besides the planned usage of administrations, the number of suppliers, those not tolerating the current Medicare plans of patients as well of other areas of suppliers. The state requires ensuring if the MCI is unable to offer the services they should offer, then it is their responsibility to take care of the costs (Holahan, Rangarajan, & Schirmer, 2018).
Medicaid and Medicare programs have similarities. In line with the oversaw plans, some units work across them. Full filing the sensible parities amongst the objectives of Medicare programs such as settling the pending installments and meeting the patients’ requirements in health care centers will always remain the primary factors for the policymakers, which will influence the availability.
The associated hazard to the person planning to buy is that the Medicare rates usually pop up annually and could easily be expensive to the person buying hence fail to bear. The deal should be given reasonable care to the person buying so that the price could below. On the other hand, Medicaid charges a few persons some premiums, and currently, they could begin charging more; hence it could be unbearable.
Another challenge is that the advantages associated with Medicare could begin to reduce soon since the sharing cost is increasing. Medicaid is having issues that make them need to switch their suppliers because they are not sufficient regarding the suppliers and the clients of this program.
Question 3
In Medicare enhancement, I suggest that it offers other projects such as vision dental and includes a better inclusion, which will make them work for the long term. Also, these programs should be made clear and progressively so that they don’t bring inconvenience of expanding the cost annually, which will stab the development rather than enhancing the Medicare plan. In this case, the best example is when people are unable to pay for the premiums. At this point, they should decline these premiums or remove them (Goldstein, Cleary, Langwell, Zaslavsky, & Heller, 2013).
In enhancing the Medicaid, I suggest that that repayment plans should be made somehow increasingly and also increase the number of suppliers to acknowledge the Medicaid. Secondly, data that concerns money should be created clearly so that the assets can be utilized primarily.
Conclusion
Medicaid and Medicare services can be improved through the utilization of the recommendations, as mentioned above. These two programs are continually providing essential services to various people in the health care industry. Medicaid and Medicare plans are playing a significant role in the health care industry. These programs work to ensure that people above 65 and those of low income get the necessary healthcare services. The government is reaching its citizens through the Medicaid and Medicare programs to ensure that its citizens are not overburdened with high costs.
References
Goldstein, E., Cleary, P. D., Langwell, K. M., Zaslavsky, A. M., & Heller, A. (2013). Medicare managed care CAHPS®: a tool for performance improvement. Health Care Financing Review, 22(3), 101.
Holahan, J., & Suzuki, S. (2012). Medicaid managed care payment methods and capitation rates in 2001. Health Affairs, 22(1), 204-218.
Holahan, J., Rangarajan, S., & Schirmer, M. (2018). Medicaid Managed Care Payment Rates In 1998: New survey data show twofold variation in what states pay managed care plans. This variation could affect plans’ participation and beneficiaries’ access to care. Health Affairs, 18(3), 217-227.